title: Short-term preoperative diet modification reduces steatosis and blood loss in patients undergoing liver resection.
abstract: BACKGROUND
  Steatosis and steatohepatitis have been associated with increased morbidity and mortality after liver resection. Our objective was to determine the effect of a preoperative calorie-restricted diet on steatosis and steatohepatitis in patients undergoing liver resection.
  
  
  METHODS
  We studied 111 consecutive patients who had major elective hepatic resections. More than 90% of the patients had cancer resections. The mean body mass index was 27.2; 32% had a body mass index ≥30. A week-long calorie- and fat-restricted diet was instituted in the most recent patient group (n = 51). We retrospectively evaluated steatosis and steatohepatitis in the diet and no-diet control groups. Clinical outcomes of the 2 groups, including complications and blood loss, were compared.
  
  
  RESULTS
  The preoperative diet patients had less steatosis (15.7% vs 25.5% of hepatocytes containing fat, P = .05) than the nondiet controls. A lower percentage of patients in the diet group had steatohepatitis than in the nondiet group (15% vs 27%, P =.02). Preoperative diet patients had less mean intraoperative blood loss than nondiet patients (600 mL vs 906 mL, P = .002). There was no difference in overall or infectious complications between the groups.
  
  
  CONCLUSIONS
  We have shown for the first time that short-term calorie restriction before liver resection significantly reduces both hepatic steatosis and steatohepatitis. Dietary modification also was associated with decreased intraoperative blood loss. This intervention is easily instituted; therefore, it is clinically feasible.
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH.
authors.forename: Justin G
authors.initials: JG
authors.lastname: Reeves
authors.forename: Arief A
authors.initials: AA
authors.lastname: Suriawinata
authors.forename: David P
authors.initials: DP
authors.lastname: Ng
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Holubar
authors.forename: Jeannine B
authors.initials: JB
authors.lastname: Mills
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Barth
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D031204:Caloric Restriction; D005234:Fatty Liver / Q000178:diet therapy* / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors